Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have a spouse / partner? *

Yes

No

Any children? *

My children will participate in RE

My children will not participate in RE

I do not have children

Your Emergency Contact *

First Name

Last Name

Their Phone

(###)

###

####

How will you sign the book of All Souls Church Unitarian members? *

I will sign in-person at church in the next 1-2 weeks.

I request a placeholder so that the next time I am in DC, I can sign the book.

I attend church remotely and do not intend to travel to DC. Please sign as my proxy.